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08-7531
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2008
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08-7531
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Last modified
3/6/2009 4:47:10 PM
Creation date
9/19/2008 10:16:51 AM
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Template:
Building Department
Building Department - Doc Type
Permit
Permit #
08-7531
Building Department - Name
ALLEGIANCE SENIOR CARE
Address
6701 DAIRY RD
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<br />2/13/2008 4:11 PM FROM: Fax A Kilbride Insurance TO: 7800021 PAGE: 002 OF 002 <br /> <br />ACORDru CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODlVY) <br />2/13/2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />A. KILBRIDE INSURANCE, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1401 w. BUSCH BOULEVARD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />TAMPA, FL 33612 INSURERS AFFORDING COVERAGE <br />(B13)931-7467 PHONE/(B13)932-7336 FAX <br />INSURED INSURER A First National Insurance Company of America <br /> T.L. Sheet Metal., Inc. INSURER 8: Mercurv Insurance Comcanu <br /> P.O. Box 8838 INSURER C First Commercial Insurance ComDanv <br /> Tampa, FL 33674 INSURER D <br /> I INSURER E <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />IW'( REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR TYPE OF INSURANCE POLICY NUMBER ~~~)'M~'b~~E Pgk{iY(~~~?N LIMITS <br />LTR <br /> GENERAL LIABILIlY EACH OCCURRENCE $ 1 000 000 <br /> - <br /> .x ~~MERCII'J.. GENERI'J.. LIABILITY FIRE DI'MAGE (Anyone fire) $ 200 000 <br /> - _I CLAIMS MADE Ci::1 OCCUR MED EXP (Anyone person) $ 10 000 <br />A 01CG2786656 12/l.2/07 12/12/08 PERSONAL & />DV INJURY $ 1 000 000 <br /> GENERAL AGGREGATE $ 1 000.000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1 000 000 <br /> ~I' II PRO- II <br /> X POLICY JECT LOC <br /> ~OMOBILE LIABILIlY COM81NED SINGLE LIMIT $ <br /> ANY AUTO lEa aCCident) <br /> >-- <br /> e-- I'J..L OWNED AUTOS 80DIL Y INJURY <br /> $ 25,000 <br /> Jt SCHEDULED AUTOS (Per person) <br />B Jt HIRED AUTOS FLC70081085 10/5/07 4/5/08 80DIL Y INJURY <br /> (Per aCCident) $ 50,000 <br /> Jt NON-OWNED AUTOS <br /> >-- PROPERTY DAMAGE $ 25,000 <br /> (Per aCCident) <br /> GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $ <br /> F=I ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONL Y AGG $ <br /> EXCESS LIABILIlY EACH OCCURRENCE $ <br /> f--- <br /> >--1 OCCUR CI CLAIMS MADE AGGREGATE $ <br /> $ <br /> F=I DEDUCTI8LE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND X hZ~/~~I~S I IUE8- <br /> EMPLOYERS' LIABILIlY WC195403 09/26/07 09/26/08 <br /> E L. EACH ACCIDENT $ 100 000 <br />C EL DISEASE - EA EMPLOYEE $ 100 000 <br /> EL DISEASE - POLICY LIMIT $ 500 000 <br /> OTHER <br />DESCRIPTION OF OPERATIONSIlOCATlONSIVEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Zephyrhil.l.s Bl.dq Dept DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br /> 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TODO SO SHALL <br /> Zephyhil.l.s, FL 33542 IMPOSE NO OBLIGATION OR LIABILIlY OF ANY KINO UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES, .- <br /> IF:::>y. R1 ~-7Rn_nn?' AUTHORIZED REPRESENTATIVE '--~ ~ <br /> <br />ACORD 25-S (7/97) <br /> <br />El ACORD CORPORATION 1988 <br />
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